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Home > Professional Reference > Ocular Diagnostic Preparations

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Ocular Diagnostic Preparations

This PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.

Fluorescein sodium1

Topical

  • Use2 - tear film assessment, identification of corneal epithelial defects/corneal disease and perforation (Seidel test).
  • Action - absorbs light in the blue wavelength and emits green fluorescence.
  • Administration - a single drop is sufficient.
  • Additional information - remember to warn patients that their eye will look yellow but that this readily wears off. They may also find that handkerchiefs stain yellow for several hours after they blow their nose. It stains contact lenses.

Seidel test to detect a wound leak:3

  • Apply concentrated fluorescein (e.g. 2% solution or directly from a moistened fluorescein strip) over the suspect area of the anaesthetised cornea, whilst observing the site with a slit lamp.
  • If there is a leak, the fluorescein dye appears as a bright green fluid oozing from the orange dye concentrate.

Systemic

  • Use - in eye units to perform fundus angiography.
  • Administration - intravenous: it remains largely intravascular and circulates in the blood stream. Patients are monitored for allergic reactions during and after the procedure.
  • Contra-indications - renal impairment and allergy to fluorescein.4
  • Side-effects5 - discolouration of the skin (yellow tinge) and urine, vomiting, itching, sneezing, vasovagal syncope, allergic reactions including anaphylaxis (1 in 1,900: severe, 1 in 220,000: fatal).

Indocyanine green4

  • Use - retinal angiography. Provides a better visualisation of the choroidal (rather than retinal) vasculature. In addition to visualising choroidal neovascularisation, it may also be helpful in assessment of inflammatory disease and choroidal tumours.
  • Administration - intravenous: remains largely intravascular.
  • Contra-indications - pregnancy, renal impairment, iodine allergy.
  • Side-effects - nausea and vomiting, sneezing and pruritus, staining of stool, vasovagal syncope and severe anaphylaxis (1 in 1,900).

Rose Bengal 1%2

  • Use - detection of corneal and conjunctival damage (dessication or devitalised tissue, e.g. good for diagnosis of keratoconjunctivitis sicca).
  • Action - stains damaged conjunctival and corneal cells.
  • Additional information - this should only be administered after applying topical anaesthetic, as it stings and may cause local irritation on application; advise patients of temporary coloured staining of the eye. The dye needs to be washed out afterwards.

Document references

  1. Summary of Product Characteristics, fluorets; Fluorescein sodium. Chauvin Pharmaceuticals Ltd: electronic Medicines Compendium. Last updated September 2007.
  2. Jackson TL. Moorfields Manual of Ophthalmology, Mosby (2008).
  3. Kunimoto DY, Kanitkar KD, Makar MS; The Wills Eye Manual, 4th Edition, 2004, Lippincott, Williams and Wilkins. ISBN: 0-7814-4207-2
  4. Denniston AKO, Murray PI. Oxford Handbook of Ophthalmology, OUP (2008).
  5. Kanski J. Clinical Ophthalmology, A Systematic Approach, 5th Ed, 2003, Butterworth Heinemann.

Acknowledgements

EMIS is grateful to Dr Olivia Scott for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2010.
Document ID: 375
Document Version: 2
Document Reference: bgp26086
Last Updated: 16 Mar 2010
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